黄斑视野测量与青光眼分期系统的相关性。
Association of Macular Visual Field Measurements With Glaucoma Staging Systems.
机构信息
Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York City, New York.
Department of Psychology, Columbia University, New York City, New York.
出版信息
JAMA Ophthalmol. 2019 Feb 1;137(2):139-145. doi: 10.1001/jamaophthalmol.2018.5398.
IMPORTANCE
Macular function is important for daily activities but is underestimated when tested with 24-2 visual fields, which are often used to classify glaucoma severity.
OBJECTIVE
To test the hypothesis that current glaucoma staging systems underestimate glaucoma severity by not detecting macular damage.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was carried out in a glaucoma referral practice. The eyes of participants with manifest glaucoma and 24-2 mean deviation (MD) better than -6 dB were included. All participants were tested with 24-2, 10-2 visual fields, and spectral-domain optical coherence tomography of the optic disc and macula.
EXPOSURES
Macular damage was based on the topographic agreement between visual field results and retinal ganglion cell plus inner plexiform layer probability plots. Classifications from the Hodapp-Parrish-Anderson (HPA), visual field index (VFI), and Brusini staging systems were examined and compared with visual field and spectral-domain optical coherence tomography results.
MAIN OUTCOMES AND MEASURES
The association between the presence of macular damage and glaucoma severity scores.
RESULTS
Fifty-seven eyes of 57 participants were included; 33 participants (57%) were women, and 43 (75%) were white. Their mean (SD) age was 57 (14) years. Forty-eight of the eyes (84% [95% CI, 72%-92%]) had macular damage by the study definition. These had a 24-2 MD mean (SD) of -2.5 (1.8); corresponding results for the 10-2 MD were -3.0 (2.4) dB and for the VFI were 94.2% (4.5%). The HPA system classified 70% (95% CI, 55%-83%) of eyes with macular damage as having early defects; the VFI system classified 81% (95% CI, 67%-91%) of eyes with macular damage as having early defects, and the Brusini system 68% (95% CI, 53%-81%).
CONCLUSIONS AND RELEVANCE
These findings suggest that current glaucoma staging systems based on 24-2 (or 30-2) visual fields underestimate disease severity and the presence of macular damage. If these results are confirmed and generalizable to other participants, new systems using macular measures (from 10-2 and spectral-domain optical coherence tomography results) might improve staging of glaucoma severity.
重要性
黄斑功能对于日常活动很重要，但在使用 24-2 视野进行测试时往往被低估，而 24-2 视野通常用于对青光眼严重程度进行分类。
目的
验证当前的青光眼分期系统通过不检测黄斑损伤来低估青光眼严重程度的假设。
设计、地点和参与者： 这是一项在青光眼转诊诊所进行的横断面研究。纳入了表现性青光眼且 24-2 平均偏差（MD）优于-6 dB 的患者的眼睛。所有参与者均接受了 24-2、10-2 视野以及视盘和黄斑的光谱域光学相干断层扫描检查。
暴露因素
基于视野结果与视网膜神经节细胞加内丛状层概率图之间的地形一致性，确定黄斑损伤情况。检查了 Hodapp-Parrish-Anderson（HPA）、视野指数（VFI）和 Brusini 分期系统的分类，并将其与视野和光谱域光学相干断层扫描结果进行了比较。
主要结果和测量指标
存在黄斑损伤与青光眼严重程度评分之间的关联。
结果
共纳入 57 名参与者的 57 只眼；33 名参与者（57%）为女性，43 名（75%）为白人。他们的平均（标准差）年龄为 57（14）岁。根据研究定义，48 只眼（84%[95%CI，72%-92%]）存在黄斑损伤。这些眼的 24-2 MD 平均值（标准差）为-2.5（1.8）dB；10-2 MD 的相应结果为-3.0（2.4）dB，VFI 为 94.2%（4.5%）。HPA 系统将 70%（95%CI，55%-83%）的黄斑损伤眼归类为早期病变；VFI 系统将 81%（95%CI，67%-91%）的黄斑损伤眼归类为早期病变，Brusini 系统将 68%（95%CI，53%-81%）的黄斑损伤眼归类为早期病变。
结论和相关性
这些发现表明，目前基于 24-2（或 30-2）视野的青光眼分期系统低估了疾病的严重程度和黄斑损伤的存在。如果这些结果得到证实且可推广至其他参与者，那么使用黄斑测量值（来自 10-2 和光谱域光学相干断层扫描结果）的新系统可能会改善青光眼严重程度的分期。
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